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UMB Cerebrovascular disease - PHAR550
Cerebrovascular disease - PHAR550
42
Pharmacology
Professional
01/16/2014

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Cards

Term
Two types of strokes:

Which is most common?

Which is most severe?
Definition
ischemic
hemorrhagic (less common/most debilitating)
Term
How is each type of stroke named?
Definition
Hemorrhagic is named by bleed location

Ischemic is named by etiology
Term
The pathway of an ischemic stroke
Definition
1. Occlusion
2. Ischemia
3. Toxic cascade
Term
What events lead to the occlusion?
Definition
Plaque formation/rupture
Term
In ischemia what is occurring to the tissue?
Definition
Reduced nutrient/waste exchange
Anaerobic metabolism
Ion shifts
Term
Explain the toxic cascade
Definition
1. Excess of excitatory A.A.
2. Inflammation mediators
3. Free radical production
Term
What co-morbidities are associated with a hemorrhagic stroke
Definition
Trauma
Infection
Uncontrolled HTN
tumor
Abnormal vessels
Term
Ultimately a hemorrhagic stroke manifests as...
Definition
Increased cranial space volume
Term
What are the 3 Cincinnati Pre-hospital Stroke Test criteria?
Definition
1. Facial droop
2. Arm drift
3. Abnormal speech
Term
Diagnosing a stroke
Definition
1. CT scan (quick)
2. MRI (longer)
Term
Ways to prevent a stroke from ever occuring
Definition
1. BP control
2. No smoking
3. Anti-platelet therapy if appropriate
4. Anti-coagulation therapy if CHADS >/= 2, or PT has A. fib
5. Statin therapy if needed
Term
Describe the line drawn across the body that determines if a pt will need anti-platelet or anti-coagulation therapy
Definition
Clot above shoulders = anti-platelet
Clot below shoulders = anti-coagulation
Term
The CHADS scale is for what type of PTs?
Definition
PTs with A. Fib!!!!!!!!
Term
CHADS
Definition
1 - CHF
1 - HTN
1 - Age >/= 75
1 - Diabetes
2 - Stroke/TIA (previous)

@ or more anti-coagulation therapy
Term
When is it okay to use rt-PA (Alteplase)?
Definition
ISCHEMIC stroke ONLY
Within the first 4 hours
Term
What are six contraindications to using rt-PA (Alteplase)?
Definition
1. Symptoms have began to improve
2. Heparin within the last 48 hours
3. Active internal bleeding
4. Intra cranial surgery in the last 3 months
5. Seizure occurred at the stroke's 6. onset
BP > 185/110
Term
How is rt-PA (Alteplase) dosed?
Definition
0.9mg/kg IV

10% bolus 90% infusion over 1 hr

Max 90mg
Term
How is rt-PA (Alteplase) monitored
Definition
Hours 1: every 15min
Hours 2-7: every 30min
Hours 8-24: every hour
Hours 25+: every shift
Term
What is monitored after rt-PA (Alteplase) administration
Definition
1. Bleeding
2. Neurological recovery
3. PT/INR/aPTT
4. Hemoglobin/Hematocrit
5. Cranial CT scan
Term
What trial confirmed rt-PA to be effective in ischemic stroke treatment?
Definition
NINDS - Nat. Institute of Neurological Disorders
Term
BY how much does rt-PA improve ischemic stroke outcomes according to the NINDS trial?
Definition
From 38.5 to 50.4%!
Term
What trial determined Aspirin to be an effective anti-platelet treatment?
Definition
The international stroke trial
Term
What trial determined that pts on aspirin had better outcomes?
Definition
CAST (Chinese Acute Stroke Trial)
[160-325mg used in trial]
Term
What is the role of uf-heparin/LMWH in stroke pts?
Definition
3-4 days after rt-PA if the pt has some paralysis, then they need uf-hep/LMWH to prevent a VTE
Term
What is the dosing of of uf-heparin/LMWH?
Definition
UFH = 5000u SQ q8-12h
Enoxaparin = 40mg SQ qDAY
Dalteparin 2500u SQ qDAY
Term
What single factor makes the largest difference in stroke recurrence?
Definition
BP CONTROL!
Term
What BP therapy is preferred in post stroke pts?
Definition
ACEi + Thiazide
Term
How is dyslipidemia treated post stroke?
Definition
80mg atorvastatin regardless of baseline LDL
Term
The brand name drug Aggrenox consist of what combination of drugs?
Definition
200mg Dipyridamole + 25mg Aspirin
Term
What trial showed a dipyridamole/aspirin combination drug like Aggrenox would be an effective treatment?
Definition
ESPS-2 European Stroke Prevention Study-2
Term
Describe the results of the CAPRIE (Clopidogrel vs. Aspirin in Pt Risk for Ichemic Events) trial
Definition
Clopidogrel is less likely to cause MI and GI hemorrhage
Term
In the CAPRIE trail clopidogrel beat out plain aspirin, but what was discovered in the ProFESS trial?
Definition
Aggrenox (cdipyridamole/aspirin combo drug) was equivalent to clopidogrel alone
Term
The MATCH (MGMT of atherothrombis w/ Clopidogrel in High riskj prs) trial compared Clopidogrel alone vs. a clopidogrel/aspirin combo products. What was the result in these pts?
Definition
The combination of clopidogrel and aspirin greatly reduced hemorragic strokes & life threatening bleeding
Term
Anti-platelet therapy should be monitored in 3 ways
Definition
1. Signs/symptoms of bleeding
2. Signs/symptoms of stroke
3. CBC
Term
How are direct XA inhibitors (rivaroxaban/apixaban) different from WARFARIN in anti-coagulation therapy?
Definition
1. Cost more
2. unable to monitor
3. no antedote
4. Higher risk of MI
Term
Which direct xa inhibitor has a storage issue?
Definition
Dabigatran
Term
Dosing of dabigatran?
Definition
Normal 150mg PO BID
Renal Reduced 75mg PO BID
Term
Dosing of rivaroxaban?
Definition
Normal 20mg PO qDAY
Renal reduced 15mg PO qDAY
Term
Dosing of apixaban?
Definition
Normal 5mg PO BID
High risk 2.5mg BID

(High risk = age>/= 80, =/< 60kg, SCr>/=1.5mg/dL)
Term
The RELY study determined
Definition
The efficacy/safety of dabigatran to be greater than WARFARIN
Term
The Rocket-AF study determined
Definition
The efficacy/safety of drivaroxaban to be greater than WARFARIN
Term
The ARISTOTLE study determined
Definition
The efficacy/safety of apixiban to be greater than WARFARIN
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